New AAP, ACOG guidance on GBS testing

Karen M. Puopolo, MD, PhD

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) have released updated guidelines on the management of Group B Streptococcus (GBS) infections in both mothers and babies.

All mothers should be tested for Group B Streptococcus (GBS) infections and treated with antibiotics during delivery if needed in order to prevent them from passing the infection on to their newborns, according to new guidance from the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG).¹

The guidance was published in Pediatrics, and is the newest update on GBS management in infants since 2010. The most common cause of neonatal sepsis is GBS, with symptoms beginning within a day or two of birth, according to the AAP. Routine screening of mothers before delivery, however, is more than 50% effective at preventing the disease, the report notes.

Mothers can be colonized with GBS without feeling sick in any way, but the disease can become very serious and quickly fatal for infants, according to the AAP.

“The AAP and the ACOG have together developed separate but aligned updated guidance on the prevention of, risk assessment for, and treatment of neonatal infection caused by GBS,” says Karen M. Puopolo, MD, PhD, chief of the Section on Newborn Medicine at Pennsylvania Hospital, associate professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine, Philadelphia, and coauthor of the new guidelines. “These separate but aligned documents replace the consensus GBS prevention guidance published in 2010 by the Centers for Disease Control and Prevention (CDC).”

A new look at GBS

The updated guidance includes more information about the epidemiology of GBS, as well as current recommendations for antibiotics. The new guidelines include intrapartum administration of penicillin G as a first-line treatment; ampicillin or cefazolin as alternatives for neonatal onset of GBS; also, treatment of women at high risk for anaphylaxis from betalactam antibiotics with clindamycin and vancomycin.

The recommendations mirror those issued in recently updated guidance from the ACOG, including the recommendation to screen for GBS between 36 and nearly 38 weeks’ gestation. The major changes in the ACOG guideline, Puopolo says, are a revision in the optimal window for antenatal GBS and new recommendations on antibiotics timing and allergy testing for mothers. The AAP endorses the ACOG recommendations and adds new risk-assessment guidance for early onset GBS disease that move away from relying on lab testing toward more complete assessments.

The new guidance is the result of new data and research, Puopolo says, with the goal being improved care for both mothers and newborns in relation to GBS.

“By moving the optimal window for GBS screening to 36 to 37 (nearly 38) weeks’ gestation, we hope to optimize the identification of GBS-colonized women and impact the incidence of neonatal GBS early-onset disease that occurs among infants born to women who screened (falsely) GBS negative,” Puopolo says.

She says allergy testing is also a big change, and that by advocating for formal penicillin allergy skin testing among pregnant women, the number of women who are unable to receive optimal intrapartum antibiotics will be reduced.

“Unlabeling women who believe they are allergic to penicillin will also optimize the women’s healthcare over time if they requires future treatment with beta-lactam antibiotics,” Puopolo says, adding that there are changes for infant care, too. “By refining approaches to risk assessment for GBS early-onset disease, we hope to evaluate and empirically administer neonatal antibiotic therapies to the highest-risk infants while minimizing laboratory evaluation and empiric antibiotic exposures among lower-risk newborns.”

References:

1. Puopolo KM, Lynfield R, Cummings JJ: Committee on Fetus and Newborn; Committee on Infectious Diseases. Management of infants at risk for Group B Streptococcal disease. Pediatrics. 2019;144(2):20191881.